Background:Peripartum management of women with pre-existing diabetes in pregnancy (DIP) is highly complex, with rapidly shifting insulin needs and obstetric crises potentially derailing glycemic control within hours. Diabetes technologies such as continuous glucose monitoring (CGM) and insulin pumps offer tighter glucose regulation but introduce challenges, particularly when numerous clinical teams are involved during labour and delivery and lack expertise with these devices.
Aim:To examine real-world peripartum glycaemic management among women with pre-existing DIP in a tertiary centre & explore associations with maternal & neonatal outcomes.
Methods:A retrospective audit of women with pre-existing DIP who delivered at a tertiary hospital between 1/6/2024 – 30/6/2025 was conducted. Data extracted from electronic records included demographics, peripartum glycaemic profiles, documented management plans, use of insulin infusions, and diabetes technologies and maternal and neonatal outcomes.
Results:Although most women had documented peripartum plans, considerable variability existed in practice. A small subgroup had persistent hyperglycaemia despite insulin therapy, leading to neonatal hypoglycaemia and prolonged length of stay. Neonatal hypoglycaemia was common, among infants of mothers needing insulin infusions. While most women achieved target glycaemic ranges, notable differences were seen in monitoring frequency, technology use, and transitions between patient-led and clinician-led management.
Conclusion:Peripartum glycemic care for women with pre-existing DIP remains vulnerable to real-world variability, even in tertiary settings. A small subgroup of women with persistent hyperglycaemia drives a disproportionate burden of neonatal complications. Bridging the gap requires not only guideline adherence but also escalation pathways, precision glycemic strategies, and upskilling clinical teams in diabetes technology.